Effects of adjunctive dobutamine on outcomes among patients with septic shock: a propensity score matching analysis

Despite some evidence supporting its utility, the role of adjunctive dobutamine in the management of septic shock remains unclear.

The nationwide prospective sepsis cohort of the Korean Sepsis Alliance was analyzed. Adult patients with septic shock receiving norepinephrine were enrolled over a 29-month period. Patients given a dobutamine infusion within 3 days of intensive care unit (ICU) admission were compared with patients who received no infusion. To balance baseline characteristics, propensity score matching (PSM) was used.

Of 11,981 patients with sepsis, 1,827 patients with septic shock receiving norepinephrine were included (108 dobutamine vs. 1,719 no dobutamine; mean age 71.4 ± 13.2 years, 59.4% male). After PSM (ratio of 1:2; 105 dobutamine patients and 209 no-dobutamine patients), Sequential Organ Failure Assessment scores and lactate levels on ICU day 3 did not significantly differ between groups. Additionally, in-hospital and ICU mortality rates did not differ between groups (54.3% vs. 48.3%, p = 0.319; 46.7% vs. 39.2%, p = 0.208, respectively). A Cox proportional model revealed that dobutamine use was not associated with in-hospital mortality (HR 1.13, 95% CI 0.81-1.58). However, subgroup analysis indicated that dobutamine use was associated with an increased risk of in-hospital mortality among patients in the lowest quintile of early fluid balance (p = 0.0286 for interaction).

Adjunctive dobutamine administration did not improve short-term organ function or hospital outcomes in septic shock patients. However, early fluid balance may influence the impact of dobutamine, highlighting the importance of a more tailored approach.